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Chronic Disease Management

Managing your health – Long Term Conditions

There have been some positive changes to how we are planning to help you manage your long-term condition(s). We call this Care and Support Planning and we want to help you be more involved in the decisions that affect you. If you have one or more of the following conditions:

  • Asthma
  • Atrial Fibrillation (AF)
  • Chronic Kidney Disease (CKD)
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Coronary Heart Disease (CHD)
  • Diabetes (Type 2)
  • Heart Failure
  • Hypertension (HT)
  • Stroke
  • Peripheral Arterial Disease (PAD)
  • Hypothyroidism

You are invited to attend, for a review, in the month of your birth every year; and how things will work are explained below.

The invitations

Administering the Long Term Conditions patients takes careful planning as the expected monthly patient totals vary; and have to planned into the overall Practice Recall programme. The LTC patient list as at February 2024 can be seen below:

The Results

Once we have the results of the information gathering appointment we will let you know if you need to contact the practice in order to arrange a Review appointment. You may not need to have a Review Appointment but if you do this will probably be a telephone appointment with the Practice Nurse, but you will be informed by our Clinical Administrators if it is to be a face-to-face or if it is to be with the GP.

You can request a copy of your results using the Practice Subject Access Request form

Click or Scan

Housebound patients

Please let us know if you are currently housebound so that we can make alternative arrangements for your care and support planning. Our Clinical Administrators have been advised of those patients who may require a home visit.

Contact details

Please take the time to check that we have your up-to-date contact details; and let us know if anything has changed.

Click or Scan to update your contact details

Summary

We do look forward to seeing you soon, but please remember that it is important that you advise the practice if you are unable to attend any of your appointments; and please feel free to contact any of our Clinical Administrators if you have any further questions.